High-Need Patients Less Likely to Receive Adequate Care

According to a report from The Commonwealth Fund, functionally limited patients who are unable to live independently are a major challenge for providers, pointing to an increased need for individually tailored interventions to better meet patients’ medical needs while decreasing costs of care.

The study examined data from the 2009-2011 Medical Expenditure Panel Survey (first conducted in 1996) fielded by the Agency for Healthcare Research and Quality, which collected information on patient demographics and socioeconomics, use of medical services, access to care, and other quality metrics.

According to the study, most high-need patients—those with functional limitations such as trouble bathing, dressing, shopping, cooking—are over the age of 75 and nearly two-thirds are women, likely due to gender differences in expected lifespan. Just under a quarter had not finished high school; seventy-five percent identified as non-Hispanic white.
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Investigators found that high-need patients generally spend twice as much on out-of-pocket health care costs as other adults, even though their average income is only $25,668. In addition, 20% of the sickest adult respondents reported going without care, not filling prescriptions, or putting off necessary services due to financial barriers.

“For high-need adults, average annual per-person spending on health care services and prescription medicines topped $21,000, nearly three times the average for adults with multiple chronic diseases only, and more than four times the average for all US adults,” the report explained.

Commonwealth Fund president David Blumenthal, MD, said in a statement, “The sickest patients have the highest medical spending but cannot reliably get the health care they need, even though they have insurance. This is a sign that our health care system is failing its most vulnerable patients. Helping patients with the greatest needs should be among the very highest priorities for efforts to improve our current system.”

Study authors argued for a team-based approach to caring for these patients, with care plans integrating family members and health care professionals to coordinate care and provide consistent patient support.

Theoretically, a holistic approach to case management should reduce unnecessary spending, provide patients with lower-cost service options, and ensure that high-need patients receive the highest possible quality care. —Amanda Del Signore